The study was supported by “A public-spirited donor” who wished to remain anonymous.

In this document lies a shocking paradigm shift with significant philosophical impact. Currently, “in the absence of adequate documented advance care planning, the default decision is to treat a disease or condition” and to provide life-sustaining care, such as CPR unless there is an advanced directive that specifically states “Do Not Resuscitate”. The IOM’s Committee recommends that the default decision change. They promote a system where a medical order should be present in the patient record in order to implement life-sustaining treatment for people of all ages with a serious illness or medical condition who may be approaching death- the default decision becoming “allow natural death”. The committee urges states to develop and implement a “Physicians Orders for Life-Sustaining Treatment” (POLST) paradigm program in accordance with nationally standardized care requirements. Are we fundamentally transforming from doctors who provide life-saving measures, unless there is a specific order to withhold them, to doctors who do NOT implement life–sustaining measures, unless there are specific orders to provide them?

The committee calls for urgent attention to the matter of dying and makes recommendations stressing the need to seek legislation and create incentives for advance care planning for everyone from neonates on up. They especially want Medicare aged people and the “frail” to have publically funded, 24/7 access to palliative care, including referral to expert-level palliative care which undoubtedly will include Physician-Assisted Suicide. Six states already offer physician-assisted dying. Such end of life planning and care is described with the words “compassion, choices, evidence-based, affordable, and sustainable,” such nice words. They report that “In the end-of–life arena, there are opportunities for savings by avoiding acute care services that patients and families do not want and are unlikely to benefit them.” They say they want to maximize independence and “Quality of Life” over living longer. Obamacare bureaucrats will be the judges of what constitutes “Quality of Life.” We are evolving from providing cure-oriented care to emphasizing palliative care and cost.

The committee points out that U.S. healthcare expenses totaled $2.8 trillion in 2012 alone. Medicare and Medicaid cost a combined $994 billion, 36% of national health expenditures. 10,000 new baby boomers enter Medicare each day, and Medicaid rolls are growing because of expansion through Obamacare. 20% of the U.S. population will be older than 65 by 2050. 2.5M people die yearly in the US, and 80% of US deaths occur among people covered by Medicare. ¼ of Medicare spending is incurred by individuals in the last year of life. The Committee seeks major reorientation and restructuring of Medicare and Medicaid including changing financial incentives and offering “positive alternatives for the end of life”. Providing palliative services instead of providing life-prolonging services to the Medicare/Medicaid population will save a tremendous amount of money.

2.) Obamacare architect and IOM member, Ezekiel Emanuel, MD tells The Atlantic “Why I Hope to Die at 75″ in a shocking article that uses the same lingo and opining as the IOM Dying article. A firestorm of commentary results, and the “end of life/death panel” debate is reignited in the public forum. Battle-fatigued Americans have seen this debate before, but we’re not as shaken as when Dr. Emanuel wrote about euthanasia and Physician-Assisted-Suicide (PAS) in The New England Journal of Medicine back in 1998, Archives of Internal medicine in 2002, and countless other publications on this issue of his fixation. If only Emanuel could have been the kind of doctor who cures cancer and AIDS, a healer who develops innovative treatment modalities that improve and lengthen life. But no, sadly, Emanuel is a world expert on rationing, death, and dying.

His “Complete Lives System” of rationing allocates resources to those between 15 and 40. He refutes the assertion that this is “ageism”, because 75 year olds already got to be 25. Honorably, the elderly and frail should not want to use resources that could otherwise go to their family or other younger people who have not yet lived a “complete life.”

3.) Medscape Business of Medicine, sister organization of Web MD that received $14M from HHS to “educate us” (propagandize) about Obamacare, publishes a report, which it disseminates to physicians, entitled “Physician-Assisted Dying: Is Resistance Eroding?” The report is a compendium of 10 articles and interviews using the same semantics of “compassion and choices” espoused by the IOM and Dr. Emanuel. An interview with Diane E Meier, MD entitled “Have We Overlooked Palliative Care as an Answer to a Patient’s Suffering?” is virtually a synopsis of talking points plucked from the IOM report on Dying and Emanuel’s “Death-wish” article. Closer inspection reveals that Dr. Meier is actually one of the 21 cherry-picked authors of the aforementioned IOM’s Dying in America report and like her colleague Emanuel, is a prolific writer in the euthanasia, physician-assisted-suicide world.

Read the compilation of Medscape articles- our money seized through usurious taxation via Obamacare funded the dissemination of this Obamacare action item. Now that we’ve got public funded abortion in the law, public funded death is just around the corner.

The name change from Physician-Assisted-Suicide (PAS) to Physician-Assisted-Death (PAD) is by design, as is this three prong “reintroduction” of death issue. It is the same people with the same ideology, agenda, and messaging repackaged.

Rita L. Marker, JD, Executive Director of the International Task Force on Euthanasia and Assisted Suicide warns that “All social engineering is preceded by verbal engineering” and that “Few people realize the vital role private foundations play in promoting societal change. More often than not, major shifts in public attitudes and public policy come not from grassroots clamor but from the hard work of a committed few activists with the ideas and the donors who fund them…Without the money that is the mother’s milk of public advocacy, those inspired to agitate for change would not get very far. The assisted suicide/ euthanasia movement typifies this phenomenon.” She points out that euthanasia and PAS/PAD advocacy group, CompassionandChoices.org, was formerly known as The Hemlock Society. The words Compassion and Choices are favorites in this trilogy of “Quality Dying” publications.

I would love to know the identity of the “public-spirited anonymous donor” for the Institute of Medicine’s Dying in America report
and the name of his or her private foundation.

This is not just a “small world” coincidence or a trite radical trial balloon launch. This is an intentional rollout of things to come, coming in talking points, Orwellian style.

Be aware of Obamacare SEC. 4305. ADVANCING RESEARCH AND TREATMENT FOR PAIN MANAGEMENT, SEC.409J. PAIN RESEARCH, and SEC. 759 PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE. These sections, combined with SEC.1181 Comparative Effectiveness Research, Patient Centered Outcomes Research Institute, and SEC. 3403 The Independent Payment Advisory Board will literally be determining end of life care for those who do not have the resources or access to seek medical care outside of Obamacare. This leaves no alternative for the truly poor and the newly deemed “in poverty” via Medicaid expansion or for seniors who have limited resources as they are forced to pay monthly premiums for Part A Medicare or forfeit their Social Security benefits.

Obamacare tells us what we CAN have, but most importantly, Obamacare tells us what we CANNOT have. This agenda is moving faster than expected. Euthanasia is rebranded as PAS, PAS as PAD, and PAD is redefined in terms of Compassion, Care and Choice. The age of Obamacare-Legislated-Death (O.L.D.) is upon us. O.L.D.- yes, bad things come in threes.

Kris Held MD is an ophthalmologist in private practice. You can follow Dr. Held on Twitter @kksheld

Comments

I am afraid I find it difficult not to regard comments on this issue from an ophthalmologist with disdain. That said, I deplore the current default which leads to so much unnecessary pain and misery for patients and families alike; but a default DNR for all patients would be even more disastrous. Attending clinicians, ER docs, intensivists should be reimbursed or otherwise systematically encouraged (NOT measured) to have frank discussions with patients and families from the outset; and withdrawal of futile care should be easier. That time is easily of equal value to, say, cataract surgery. When we have these discussions it is not for reimbursement nor based on political ideology, but because we care about our patients and take pride in giving the best care possible.

No exactly sure why the disdain for ophthalmologists. ie: the doctors that make the blind see? I actually find it quite the metaphor for what Dr. Held does throughout her life. Thanks for this article Kris. Definitely eye-opening.

Might we not have another example of the Baptist and Bootlegger phenomenon.Look at the committee’s resumes.You find a number of folks who represent the palliative care movement including at least one with ties to Hastings and some with current or previous positions with the third party payers, eg. Well Point, Blue Cross/Shield and CMS .The Mafia rule frequently has useful explanatory power.Who might benefit from IOM/s proposals,? maybe the palliative care folks and the third party payers.The more I think about it the more it seems that some (much?)of what IOM does tends to benefit the third party payers.